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Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: Apparent opioid-related deaths in Canada (January 2016 to June 2017) Web-based Report. Ottawa: Public Health Agency of Canada; 2017.

Canada is experiencing a serious and growing opioid crisis. Across the country, it is having devastating effects on families and communities.

Accurate information about the crisis will help the efforts to reduce opioid-related harms and deaths.

The Government of Canada is working closely with the provinces and territories to collect and share data on apparent opioid-related deaths. The data will be updated four times a year and may change based on review and refinement.

The data in this report should be interpreted with caution due to provincial and territorial differences in the processing and reporting of apparent opioid-related deaths. In addition, please refer to the Considerations and Limitations for more information.

Key Findings

According to data reported as of December 11, 2017:

in 2016, there were 2,861 apparent opioid-related deaths in Canada

from January to June 2017, there were at least 1,460 apparent opioid-related deaths and it is expected that this count will rise as additional data become available

overall, most apparent opioid-related deaths occurred among males (74%) and among individuals between the ages of 30 and 39 (28%)

from January to June 2017, 74% of apparent opioid-related deaths involved fentanyl or fentanyl analogues, compared to 53% in 2016.

The data in this report:

are updated on a quarterly basis

may change based on review and refinement

have been collected by the provinces and territories from their respective offices of Chief Coroners/Medical Examiners

have been shared through the Special Advisory Committee on the Epidemic of Opioid Overdoses (SAC)

Changes from last report include:

the addition of available preliminary data from April to June 2017 (except for Manitoba, Quebec and Newfoundland and Labrador)

updates to preliminary data from 2016 and January to March 2017

National and regional trends of apparent opioid-related deaths

The opioid crisis has affected every part of the country, but some provinces and territories have been impacted more than others. According to data reported as of December 11, 2017:

there were 2,861Footnote a apparent opioid-related deaths in Canada in 2016, corresponding to a death rate of 7.9Footnote a per 100,000 population (Table 1)

there were at least 1,460 apparent opioid-related deaths from January to June 2017 (Table 1)

Footnotes

N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the Considerations and Limitations for more information.

Footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids.

Only data from May to June 2017 were available for Ontario; data from January to April 2017 were not available at the time of this publication. Updates to historical data will be provided in future reports.

Footnotes

N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the Considerations and Limitations for more information.

Footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids.

Only data from May to June 2017 were available for Ontario; data from January to April 2017 were not available at the time of this publication. Updates to historical data will be provided in future reports.

Suppressed – Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the Considerations and Limitationsfor more information.

Figure 2 Footnote 1

Not all provinces and territories were able to report data for the full time period (January 2016 to June 2017). Figure 2 includes 2016 data only for Quebec, 2016 data and 2017 data limited to May to June only for Ontario, and data from January 2016 to March 2017 only for Manitoba and Newfoundland and Labrador. Saskatchewan, Quebec and Prince Edward Island report closed cases only. Updates to historical data will be provided in future reports. Refer to Table 6 for more details.

Footnotes

N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the Considerations and Limitations for more information.

Footnote 1

Not all provinces and territories were able to report data for the full time period (January 2016 to June 2017). Table 3 includes only 2016 data for Quebec, 2016 data and 2017 data limited to May to June only for Ontario, and data from January 2016 to March 2017 only for Manitoba and Newfoundland and Labrador. Saskatchewan and Prince Edward Island report closed cases only. Updates to historical data will be provided in future reports. Refer to Table 6 for more details.

Apparent opioid-related deaths often involveFootnote b multiple substances including one or more opioids as well as non-opioid substances. Knowing the type(s) of opioid and non-opioid substances involved in these deaths can help public health officials and other government agencies communicate risks and target harm reduction efforts.

Similar to previous updates, we are seeing more fentanyl or fentanyl analogues involved in apparent opioid-related deaths (Table 4, Table 5). According to available data reported as of December 11, 2017:

the percent of deaths involving fentanyl or fentanyl analogues was 53% in 2016 and 74% from January to June 2017Footnote c

the number of apparent opioid-related deaths involving fentanyl or fentanyl analogues more than doubled in January to June of 2017 compared to the same time period in 2016

Non-opioid substances

We can also highlight the involvement of non-opioid substances in apparent opioid-related deaths.

According to available data, approximately 82% of apparent opioid-related deaths from January 2016 to June 2017Footnote d also involved one or more types of non-opioid substances.

Table 4. Number and percent of apparent opioid-related deaths involving fentanyl or fentanyl analogues by province or territory, 2016 and January to June 2017.

Footnotes

N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the Considerations and Limitations for more information.

Please note: Higher percentages in 2017 compared to 2016 of apparent opioid-related deaths involving fentanyl or fentanyl analogues should be interpreted with caution. The observed differences between the two time periods may reflect relative increases in the numbers of deaths involving fentanyl or fentanyl analogues, or may reflect a delay in the reporting of deaths involving non-fentanyl-related opioids in some jurisdictions. Furthermore, these data are preliminary and are subject to change.

Footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids. British Columbia data on deaths related to illicit drugs where fentanyl was detected is used here to approximate apparent opioid-related deaths involving fentanyl.

This table reflects Ontario data from May to June 2017 for closed cases only; data from January to April 2017 were not available at the time of this publication. Updates to historical data will be provided in future reports.

Footnotes

N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the Considerations and Limitations for more information.

Footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids. British Columbia data on deaths related to illicit drugs where fentanyl was detected is used here to approximate apparent opioid-related deaths involving fentanyl.

Only annual totals were available for Saskatchewan, quarterly data were not available at the time of this publication. Saskatchewan reports closed cases only. Updates to historical data will be provided in future reports.

This table reflects Ontario data from May to June 2017 for closed cases only; data from January to April 2017 were not available at the time of this publication. Updates to historical data will be provided in future reports.

As of May 1, 2017, apparent opioid-related death data in Ontario were captured using an enhanced data collection tool by the Office of the Chief Coroner. Only 2016 data and 2017 data limited to May to June were available; data from January to April 2017 were not available at the time of this publication. Updates to historical data will be provided in future reports.

Quebec data for individuals 19 years and younger were not available at the time of this publication. Quebec data were available for closed/certified cases only; 44% of the cases for 2016 were still under investigation. Updates to historical data will be provided in future reports.

Data suppression

The suppression of data in this report is based on the preferences of individual provinces or territories to address concerns around releasing small numbers for their jurisdiction.

Prince Edward Island suppressed counts less than five for total and quarterly data, and for any data regarding sex and age distribution. However, if the total annual count of apparent opioid-related deaths is greater than four, annual counts less than five may be reported when presenting type of substance(s).

Newfoundland and Labrador suppressed all counts less than five.

Nunavut suppressed all counts less than five.

While Yukon has typically suppressed counts of less than five, the decision was made between the Chief Medical Officer of Health and the Chief Coroner, to release smaller counts, due to the urgency of the current opioid crisis, the value of detailed ongoing surveillance, and the importance of being as transparent as possible while still maintaining confidentiality with respect to case details.

Opioids and other involved substances

Fentanyl and fentanyl analogues include, but are not limited to:

3-methylfentanyl

acetylfentanyl

butyrylfentanyl

carfentanil

despropionyl-fentanyl

fentanyl

furanyl-fentanyl

norfentanyl

Non-fentanyl-related opioids include, but are not limited to:

buprenorphine metabolites

codeine

dihydrocodeine

heroin

hydrocodone

hydromorphone

loperamide

meperidine

methadone

monoacetylmorphine

morphine

normeperidine

oxycodone

tapentadol

tramadol

U-47700

Non-opioid substances include, but are not limited to:

alcohol

benzodiazepines

cocaine

W-18

Limitations of these apparent opioid-related deaths data

Data presented in this report should be interpreted with caution:

This report is based on data submitted to the Public Health Agency of Canada on or before December 11, 2017. New or revised data submitted after this date will be reflected in future updates.

Data released by provinces and territories may differ from the data provided in this report due to the availability of updated data, differences in the type of data reported (e.g. manners of death), alternate age groupings, differences in time periods presented, etc.

As some data are based on ongoing investigations by coroners and medical examiners, they are considered preliminary and subject to change. Data are considered closed (certified) after completion of the death investigation by the coroner/medical examiner. The time required to complete an investigation and related administrative processes is case-dependent and can range from approximately 3 to 24 months.

This report does not distinguish between pharmaceutical and non-pharmaceutical opioids, or prescription and non-prescription drugs, which may have differing levels of potency.

Jurisdictional differences in the death investigation process, death classification method, toxicology testing and type of data reported (e.g. intentional/suicide deaths included or excluded) may impact the interpretation and comparability of the reported data.

Information related to changes over time at the national level is based only on jurisdictions where data were available for all time periods of interest.

Rates reported here have not been age-standardized and therefore have not been adjusted for existing differences in provincial and territorial age distributions.

Rates for jurisdictions with smaller populations may change substantially with even slight changes in the number of deaths; comparisons over time and between jurisdictions should be interpreted with caution.

Footnotes

Footnote a

The revised number and rate of apparent opioid-related deaths in 2016 reflects updates to provincial or territorial data.

These percentages are based only on jurisdictions where data were available for both time periods. Higher percentages in 2017 compared to 2016 of apparent opioid-related deaths involving fentanyl or fentanyl analogues should be interpreted with caution. The observed differences between the two time periods may reflect relative increases in the numbers of deaths involving fentanyl or fentanyl analogues, or may reflect a delay in the reporting of deaths involving non-fentanyl-related opioids in some jurisdictions. Furthermore, these data are preliminary and are subject to change.

Data were not available from British Columbia, Saskatchewan, and Quebec. Not all provinces and territories were able to report data for the full time period (January 2016 to June 2017). This percentage includes only 2016 data for Ontario, data from January 2016 to March 2017 only for Manitoba and Newfoundland and Labrador, and data from Alberta for closed cases only. Ontario data do not include alcohol as one of the non-opioid substances.